Eligibility Determination Processes

Hi Everyone! 

For MN, one of our goals in participating in the HSPA is to strengthen and make more efficient our administration of the Housing Stabilization Services - a 1915(i) benefit. 

As part of that goal, I'm interested in learning how eligibility for the housing focused Medicaid benefit is determined in other states. 

There is further detail and nuance to our process that I won't dive into here, but here is how our eligibility determination process works in a big picture kind of way:

  • HSS providers submit an application for individuals through an online portal that includes documentation of both their functional eligibility (completed by a qualifying professional) and their housing-focused person-centered plan (completed by a Housing Stabilization Services provider as part of the Consultation Service).
  • These items are then reviewed by State staff and eligibility (approval or denial) is determined. 
  • As a reference point, we are currently receiving around 3,500 applications per month and it is taking around 40 days for processing.  

I am interested in knowing from other states

  • What is required to be submitted for eligibility determination? 
  • Who makes the eligibility determination? 
  • How long does the eligibility determination take? Days? Weeks? 

Any info from other States would be greatly appreciated! And let me know if you have any questions about our process. Thanks! 

3 replies

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    • Department of Human Services
    • Tawana_Holland
    • 8 days ago
    • Reported - view

    In DC we have successfully completed the first year of our 1915i benefit.  I will be presenting on May 16th to this group, but I am open to discussing it with you individually. We conduct our eligibility through the CAHP Coordinated Entry process and then we, DHS completes the Intake (Conflict Free Assessment) so they can choose their person-centered goals and a HSS Provider. Please email me at tawana.holland@dc.gov for more immediate information.

    • Department of Social and Health Services (DSHS) Aging and Long-Term Support Administration (ALTSA)
    • Whitney_Joy_Howard
    • 8 days ago
    • Reported - view

    Hi Tom! In Washington we have been utilizing the 1115 Waiver for Supportive Housing and Supported Employment benefits since January 2018. We have a Third Party Administrator, Wellpoint, for what we call Foundational Community Supports. Wellpoint contracts with providers, handles all aspects of referrals, opens service authorizations, and handles billing and claims.  Lots of information on the link I hyperlinked to, but you can check out eligibility here.

    Most of the eligibility criteria Wellpoint can look up to make determinations on eligibility based on our MMIS system, HMIS, and/or WA State's PRISM score. The Aging and Long-Term Support Administration (where I work) or community facilities can provide verification of other eligibility criteria based on dates of stay. For homelessness, here is the guidance on documentation. My Health Care Authority colleagues can provide you more specific or detailed information regarding eligibility determination.

    Wellpoint has 5 business days to process referrals/confirm eligibility.

    • Department of Economic Security
    • Megan_Akens
    • 2 days ago
    • Reported - view

    Arizona has an 1115 waiver.

    Here is our Division of Developmental Disabilities Eligibility Process. https://des.az.gov/services/disabilities/developmental-disabilities/determine-eligibility

    Here is our AHCCCS( State Medicaid Agency Eligibility

    https://www.azahcccs.gov/AHCCCS/Downloads/AHCCCSEligibility.pdf

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